Minutes of the Health Commission Meeting Tuesday, June 18, 2002 At 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The Health Commission meeting was called to order by Commissioner Edward A. Chow, M.D. at 3:10 p.m. Present: Commissioner Edward A. Chow, M.D., President Commissioner Roma P. Guy, M.S.W., Vice President Commissioner Arthur M. Jackson Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sanchez, Ph.D. Absent: Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JUNE 4, 2002 Action Taken: The Commission (Chow, Guy, Jackson, Monfredini, Parker, Sanchez) approved the minutes of the June 4, 2002 Health Commission meeting. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE Commissioner Jackson chaired and Commissioner Monfredini attended the Budget Committee meeting. Commissioner Umekubo was absent. (3.1) Central Administration-MIS - Request for approval of a sole source software maintenance agreement renewal with The Echo Group in the amount of $411,597, to provide ongoing system maintenance and application support services for the INSYST software application used by Community Mental Health Services, for the period of July 1, 2002 through June 30, 2003. (3.2) Central Administration-MIS - Request for approval of a sole source software maintenance agreement renewal with InfoMC in the amount of $254,160, to provide ongoing system maintenance and application support services for the CCURA3 software application used by Community Mental Health Services, for the period of July 1, 2002 through June 30, 2003. (3.3) CHN-SFGH Pharmacy - Request for approval of contract renewals with the following two firms: Asereth Medical Services, Inc. and Rxrelief, for a combined total amount of $1,200,000 to provide as-needed supplemental pharmacy personnel services to the Community Health Network for the period of July 1, 2002 through June 30, 2003. Commissioners’ Comments: Commissioner Jackson asked why Rxrelief charges more for licensed pharmacists than Asereth. Dr. Kotable replied that Rxrelief requested an increase because of the difficulty of recruiting pharmacists. Commissioner Jackson said that the next time these contracts come before the Commission for approval he wants to see the same rates for both. Commissioner Monfredini concurred. (3.4) CHN-SFGH Radiology - Request for approval of a contract modification with The Registry Network, Inc. to reduce the amount of the contract from $700,000 to $395,000 to provide as-needed, professional radiology technologists, with on-call availability 7 days a week for the period of September 1, 2001 through August 31, 2003. Items 3.4 and 3.5 were discussed together. Commissioners’ Comments: Commissioner Monfredini asked if it was difficult to recruit and retain radiology staff because there is not the pool to recruit from or because salaries are not high enough. Mr. Sass replied that they are difficult to recruit for even with high salaries. Ms. Zmuda added that in this fiscal year the Department increased salaries for radiology technology classes by roughly 15 percent. Once this more competitive salary is in place, staff can better recruit and there will not be as high a turnover rate. And while there is a selective hiring freeze, this will not apply to this class of employees because of the lengthy waiting lists for radiological procedures, such as mammograms. (3.5) CHN-SFGH Radiology - Request for approval of a new sole source contract with Medical Contracting Services, Inc., to provide intermittent, as-needed, traveling professional radiology technologists in the amount of $175,000 for the period of July 1, 2002 through June 30, 2003. (3.6) CHN-Facilities Management - Request for approval of contract modifications with the following fourteen (14) firms: Acker & Guerrero Roof Co., Inc., Adolph Schmidt General Contractors, Agbayani Construction, Inc., Anderson Carpet & Linoleum Sale Co., Inc., Angotti & Reilly, Inc., Ayoob & Peery Plumbing, Baca & Sons Painting, Floortrends Inc., McClure Electric, Inc., Monticelli Painting & Decorating, Inc., Robert Poyas, Inc., Sabel Painting Co., Sierra Electric Co. and The Shooter Co., to increase the combined contract amount by $2,000,296 from $5,987,500 to $7,987,796, to provide intermittent, as-needed facility maintenance services above baseline civil services staffing and extend the current contract period of July 1, 2000, through June 30, 2002, by six (6) months through December 31, 2002. (3.7) CHN-Office of Managed Care - Request for approval of a contract renewal with San Francisco Health Plan in the amount of $3,900,000, to provide universal health insurance coverage for San Francisco children for the period of July 1, 2002 through June 30, 2003. (3.8) CHP - Community Mental Health Services - Request for approval of a retroactive new contract with Alta Bates Summit Medical Center in the amount $15,000 for the first year and $80,000 per year thereafter in non-MediCal funds, and to share in a pool of MediCal funds of up to $4,300,000 per year, to provide inpatient psychiatric services for adults and adolescents and transitional outpatient services for adolescents for a total contract amount of $255,000 in non-MediCal funds, for the period of July 1, 2001 through June 30, 2005. (3.9) CHP - Community Mental Health Services - Request for approval of a new contract with Bay Area Bookkeeping in the amount of $625,000, to provide check writing services for payment to non-contract providers of the San Francisco Mental Health Plan (SFMHP) and Family Mosaic Project (FMP), for the period of July 1, 2002 through June 30, 2003. (3.10) CHP-Primary Care - Request for approval of a contract renewal with St. Mary Prescription Pharmacy, in the amount of $135,000, to provide as-needed pharmacy services for clients of the Youth Guidance Center and associated programs, for the period of July 1, 2002 through June 30, 2003. (3.11) CHP-Primary Care - Request for approval of a sole source contract renewal with North of Market Senior Services, in the amount of $202,685 per year, for a total four-year amount of $810,740, to provide comprehensive primary care services to seniors, for the period of July 1, 2002 through June 30, 2006. (3.12) CHP-Primary Care - Request for approval to accept and expend a new one-year grant from the Franklin Benevolent Corporation, in the amount of $75,000, to support enhancement and expansion of Podiatry, Nutritionist, and Diabetic Nurse Educator services for the period of July 1, 2002 through June 30, 2003. (3.13) PHP-Bureau of Environment Health Management - Request for approval to accept and expend retroactively a new grant from the State of California Department of Health Services, in the amount of $204,352, to develop and implement plans for public health preparedness and response to bioterrorism for the period of February 15, 2002 through August 31, 2003. (3.14) PHP-Bureau of Environment Health Management - Request for approval of a contract renewal with Romic Environmental Technologies, in the amount of $250,000 per year, for a total contract value of $500,000, to provide hazardous waste management and transportation services for the period of July 1, 2002 through June 30, 2004. (3.15) CHPP - Health Promotion Section - Request for approval of a contract renewal with Polaris Research and Development in the amount of $150,000, to provide project evaluation services for the Tobacco Free Project, for the period of July 1, 2002 through June 30, 2003. (3.16) CHPP - Health Promotion Section - Request for approval of a contract renewal with the San Francisco Study Center in the amount of $596,752, to provide fiscal sponsor services for the Community Capacity-Building Training Center for the Tobacco Free Project, for the period of July 1, 2002 through June 30, 2003. Action Taken: The Commission (Chow, Guy, Jackson, Monfredini, Parker, Sanchez) approved the Budget Committee consent calendar. 4) DIRECTOR’S REPORT Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report. Funding to Expand Services at Potrero Hill Health Center The Franklin Benevolent Corporation has awarded a grant of $75,000 to Potrero Hill Health Center to support additional clinical staff in podiatry, diabetes, nurse education, and nutrition. Protocol Approved for Clinical Pharmacists A new law (AB 826) passed in January 2002 expands pharmacists’ scope of practice in outpatient settings to include initiating and adjusting drug therapy under protocols developed by a multi-disciplinary group of health professionals, including physicians. A new procedure and protocol was recently approved by Community Mental Health Services to formally recognize the expanded role of clinical pharmacists in providing increased support to medical staff. Community Mental Health Services Consumer Fair CMHS Cultural Competence and Consumer Relations held its first annual Mental Health Fair at the Main Public Library on May 31, 2002. It was held to commemorate May as Mental Health Awareness Month. The fair was coordinated, planned and held by consumers for consumers. Historic Photos Donated to DPH A Millbrae resident, Keith Collins, recently acquired a box of old San Francisco Department of Public Health photos from an estate auction and has donated them to the Department. The subjects range from a 1908 School of Nursing shot, some 1920's Health Clinics when Public Health was located on Mission Street, and a broad collection of 1940's public health nursing and child health exams. Many of the later photos were taken here at 101 Grove Street. One photo of special interest depicts a technician cleaning hypodermic needles. The collection was put into an album until it is decide the best use for them, which will include public display and appropriate archival treatment. Mr. Collins is here today to officially present these photos to the Health Commission. Eileen Shields gave a slide presentation of a sampling of the historic photographs that were donated to the Department of Public Health by Keith Collins. The photographs will be scanned and placed in the archives at San Francisco General Hospital. Mr. Collins also showed the Commission a San Francisco Hospital medical yearbook from 1929. The Health Commission thanked Mr. Collins for these irreplaceable photographs. Commissioner Chow presented a certificate to Lois Borgmann for her 38 years of service to the Department of Public Health as a public health nutritionist. The Commission wished her well in her retirement. Commissioners’ Comments: Commissioner Chow asked Dr. Katz to clarify whether AB 826 allows pharmacists to prescribe medication. The law does allow that if a multidisciplinary group of physicians, pharmacists and nurses have agreed that a certain patient should start on a certain medication if certain conditions exist, the pharmacist can prescribe. Dr. Katz said that everything has to be set via protocol. Dr. Chow wants a follow-up report at the Community Health Network Joint Conference Committee to see how CMHS is utilizing this new procedure protocol and if it has enhanced the services. 5) HEALTHY KIDS UPDATE Jim Soos, Department of Public Health Policy and Planning, introduced Jean Fraser, Executive Director of the San Francisco Health Plan (SFHP), who presented the Healthy Kids Program update. The Healthy Kids program provides complete health insurance, including dental and vision care, to San Francisco residents aged 0-19 who are ineligible for the Medi-Cal or Healthy Families and whose family earns less than 300 percent of the Federal Poverty Level (FLP). Children are eligible regardless of immigration status. Families pay a $4 per month premium. The Healthy Kids Program opened for enrollment January 1, 2002 and coverage began February 1, 2002. Ms. Fraser said that are approximately 5,000 children in San Francisco are eligible for the Healthy Kids program. This number was based on data that there are 9,000 uninsured children in San Francisco, 1,000 of who are from families earning more than 300% of FLP. Another 3,000 children are believed to be eligible for Medi-Cal or Healthy Families. After five months of enrollment, 25% of total target population has been enrolled-1,243 as of June 1, 2002. In addition the San Francisco Health Plan has processed children who are eligible for Healthy Families and Medi-Cal. Marketing and Outreach efforts included collaboration with community and faith-based organizations to launch Healthy Kids via three citywide enrollment events on Healthy Kids Day (January 13), attended by 2000 people. Efforts are focusing first on clinics and hospitals servicing uninsured. SFHP is partnering with schools and others targeted CBOs and there is an on-going public relations and media campaign. While the SFHP is the primary enroller for the program, the neighborhood and DPH clinics are also doing enrollment. Jim Soos presented demographic data on current enrollees: Age - One quarter under age 6, one third between 6 and 10 and 40 percent are between 11 and 19. One surprising fact has been the enrollment of adolescents, approximately 12% thus far. This is one population they were told would be difficult to reach. The largest ethnic population, at 63%, is Latinos followed by 34% Asian Pacific Islanders. These are followed by Whites, African Americans and Native Americans Language is reflective of the ethnic breakdown of members. 62% speak Spanish and 25% speak Chinese. The average family income is $2,023 per month, average family size is 3.55 members, average percentage of FPL is 145%. Staff estimates that 79% of enrollees are undocumented, because this percentage of families earns less than 250% of FLP. They would be eligible for Healthy Families or Medi-Cal if they were citizens. One half of enrollees have chosen CHN as their provider. Funding San Francisco is the first city in the nation to make a commitment to fund universal health care for children from the city budget. While other city’s have similar programs, they are not supported with general fund dollars. The cost for FY 02-03 is approximately $3.9 million, including outreach. Two sources of funding are the City’s general fund and a limited-term contribution from the Tobacco Tax/Proposition 10 fund for the ages 0-5 population. The Department felt that premiums were important. They help the health plan keep in contact with the families and allow them to see if families still live in San Francisco. In addition families have indicated that they want to pay for their children’s coverage because research has shown that families believe they get better health care if they pay something for it. The Health Plan has worked to overcome barriers to premiums, including quarterly billing and a hardship assistance program. Meeting the Strategic Plan Expands health care coverage to the uninsured Focuses on target populations: children, youth and low-income families Reaches target neighborhoods Addresses social and economic determinants of health Enhances revenue for providers including CHN Fosters partnerships with other community organizations Successes Great community support and media support 115 certified application assistors trained. Enrolled 25% of target populations in only 5 months One step closer to universal health care and fulfilling the SFHP mission Enrolling more children in Medi-Cal and Healthy Families; message to families is much clearer San Francisco is inspiring other counties to develop similar programs Challenges Difficulty with African American enrollment. Currently there are only three African American enrollees. One of the reasons may be Medi-Cal eligibility. Second, the target thus far has been the undocumented populations and far fewer African Americans in San Francisco are undocumented. Also, according to census data there has been a steady drain of African American families out of San Francisco. Finally, outreach messages may be different for this community. In looking at the data for the Universal Task Force Blue Ribbon Committee, staff estimates that 0.5% of uninsured African American ages -17 fall within the 200%-300% of FLP. Despite these low numbers, SFHP is working actively to do outreach in the African American Community. Dr. Katz asked if staff could get data about the number of African Americans who apply for Healthy Kids but are enrolled in Medi-Cal because this is a victory. Efficiency of the dental access component. It has taken Delta Dental longer than they had hoped for Delta Dental to develop this program. Overcoming cultural competency issues. They found two significant issues. First, for many people who come from outside the American medical system, it is not culturally relevant to take a child to the doctor if he or she is not sick. Second, people who are ill go to a clinic without an appointment. SFHP has been calling members to encourage them to make an appointment and are supportive of the move toward same day appointments at DPH clinics. Looking forward Targeting 4,000 members by the end of FY02-03 Access federal and state funds Retention strategies - continuous contact with families; phone contact for re-enrollment Development and implementation of evaluation program. Commissioners’ Comments: Commissioner Parker asked if a family moves out of the city is automatically disenrolled and if they get a refund if they have prepaid for a year. Ms. Fraser said the State only allows them to serve people who live in San Francisco. Two other counties-Alameda and Santa Clara-have similar programs, which families moving to those areas are referred to. They would probably refund a portion of their premium if the family requested it. Commissioner Parker asked how many African American children would be eligible for this program. Mr. Soos said they estimate between 13 and 25 children. Commissioner Parker asked if it makes economic sense to go forward with a large promotional program for this number of people. Mr. Soos replied that the outreach programs educate and connect people to all the insurance programs, including Medi-Cal and Healthy Families, so there is a benefit. Commissioner Parker asked about the revenue impact of Healthy Kids. Ms. Zmuda said staff has estimated $500,000 in revenue resulting from premium, with the majority of revenues going into primary care. Commissioner Parker said that the health disparities in the African American population would not only continue but also get larger, if we cannot address these issues. Commissioner Chow re-emphasized that regardless of which program the children are enrolled in, the fact that African American families are getting connected to insurance programs is an accomplishment. Commissioner Chow requested demographic data about African Americans in San Francisco, including income, as well as data on enrollment in Healthy Families by ethnicity. He stated that the Commission needs a follow-up report to ensure that the program is reaching the right people with the right project, and to see if the African American population is adequately insured. In addition to the October joint report with Healthy Families, Commissioner Chow would like a report in February 2003, which would mark the one-year anniversary of the program. Commissioner Guy said that this is very important because African American families have higher risk factors and a higher burden of ill health, and we need to make sure they are getting preventive care. It would be helpful if the Commission had written information about plans to address this issue, as well as the number of people who are enrolling in Medi-Cal. She asked if the Department and SFHP are working with children in family day care programs. DPH is working with the Children’s Council and Wu Yee. Commissioner Guy said that there are other populations that carry higher health burdens, for example Filipinos and Samoans. Mr. Soos said SFHP is tracking these populations. Commissioner Monfredini asked if children must have a parent to enroll in Healthy Kids. Ms. Fraser said no. Commissioner Monfredini asked how we are outreaching to adolescents between 16 and 19 who live independent from their parents. Ms. Fraser said they would reach these youth if they go to a clinic, go to a school that the health plan has worked with and via advertising in the Bayview. Ms. Fraser added that most likely these kids will be eligible for Medi-Cal. Commissioner Jackson suggested that information about Healthy Kids be placed in emergency rooms, since many African Americans receive care there. He also asked what percentage of African Americans fall between 100% to 250% of FPL. Mr. Soos said that less than 2% of African Americans are enrolled in San Francisco’s Healthy Families program, which covers people in this income bracket. Commissioner Jackson said it is incredibly tragic that so many African American families live below 100% of FPL. Commissioner Sanchez said one of the major concerns statewide was the under enrollment of the Hispanic population and undocumented children. San Francisco has done a great job in enrolling this population. Additional data will allow us to chart new pathways to reach the uninsured. 6) PUBLIC COMMENTS Elizabeth Frantes - She almost was bitten by a pit bull at Sutro Park. The park police are ineffective. Children need to be protected from unleashed dogs. Animal Care and Control needs to reform what is going on. The judge’s ruling this morning was ludicrous. The Police Department and National Park Service does not enforce the leash laws. Everybody is passing the buck on who’s responsible. 7) ADJOURNMENT The meeting was adjourned at 4:40 p.m. Michele M. Olson, Executive Secretary to the Health Commission